Form C-147 "Permit or Registration for Recycling and Re-use of Produced Water, Drilling Fluids and Liquid Oil Field Waste (Including Recycling Containment)" - New Mexico

What Is Form C-147?

This is a legal form that was released by the New Mexico Energy, Minerals and Natural Resources Department - a government authority operating within New Mexico. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 3, 2017;
  • The latest edition provided by the New Mexico Energy, Minerals and Natural Resources Department;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form C-147 by clicking the link below or browse more documents and templates provided by the New Mexico Energy, Minerals and Natural Resources Department.

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Download Form C-147 "Permit or Registration for Recycling and Re-use of Produced Water, Drilling Fluids and Liquid Oil Field Waste (Including Recycling Containment)" - New Mexico

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State of New Mexico
Form C-147
District I
Revised April 3, 2017
1625 N. French Dr., Hobbs, NM 88240
Energy Minerals and Natural Resources
District II
Department
.
811 S. First St., Artesia, NM 88210
District III
Oil Conservation Division
1000 Rio Brazos Road, Aztec, NM 87410
1220 South St. Francis Dr.
District IV
1220 S. St. Francis Dr., Santa Fe, NM 87505
Santa Fe, NM 87505
Recycling Facility and/or Recycling Containment
Type of Facility:
Recycling Facility
Recycling Containment*
Type of action:
Permit
Registration
Modification
Extension
Closure
Other (explain) ___________________
* At the time C-147 is submitted to the division for a Recycling Containment, a copy shall be provided to the surface owner.
Be advised that approval of this request does not relieve the operator of liability should operations result in pollution of surface water, ground water or the environment.
Nor does approval relieve the operator of its responsibility to comply with any other applicable governmental authority's rules, regulations or ordinances.
1.
Operator: ______________________________________________(For multiple operators attach page with information) OGRID #:_______________
Address: ____________________________________________________________________________________________________________________
Facility or well name (include API# if associated with a well): __________________________________________________________________________
OCD Permit Number: ___________________________(For new facilities the permit number will be assigned by the district office)
U/L or Qtr/Qtr ______________ Section ____________ Township ____________ Range ____________ County: ________________________________
Surface Owner:
Federal
State
Private
Tribal Trust or Indian Allotment
2.
Recycling Facility:
Location of recycling facility (if applicable): Latitude __________________________ Longitude __________________________ NAD83
Proposed Use:
Drilling*
Completion*
Production*
Plugging *
*The re-use of produced water may NOT be used until fresh water zones are cased and cemented
Other, requires permit for other uses. Describe use, process, testing, volume of produced water and ensure there will be no adverse impact on
groundwater or surface water.
Fluid Storage
Above ground tanks
Recycling containment
Activity permitted under 19.15.17 NMAC explain type___________________________
Activity permitted under 19.15.36 NMAC explain type:___________________________
Other explain __________________________
For multiple or additional recycling containments, attach design and location information of each containment
Closure Report (required within 60 days of closure completion):
Recycling Facility Closure Completion Date:_______________________
3.
Recycling Containment:
Annual Extension after initial 5 years (attach summary of monthly leak detection inspections for previous year)
Center of Recycling Containment (if applicable): Latitude _________________________ Longitude _______________________ NAD83
For multiple or additional recycling containments, attach design and location information of each containment
Lined
Liner type: Thickness _________mil
LLDPE
HDPE
PVC
Other ___________________________
String-Reinforced
Liner Seams:
Welded
Factory
Other _______________________ Volume: __________bbl Dimensions: L______ x W______ x D______
Recycling Containment Closure Completion Date:_______________________
Oil Conservation Division
Page 1 of 3
State of New Mexico
Form C-147
District I
Revised April 3, 2017
1625 N. French Dr., Hobbs, NM 88240
Energy Minerals and Natural Resources
District II
Department
.
811 S. First St., Artesia, NM 88210
District III
Oil Conservation Division
1000 Rio Brazos Road, Aztec, NM 87410
1220 South St. Francis Dr.
District IV
1220 S. St. Francis Dr., Santa Fe, NM 87505
Santa Fe, NM 87505
Recycling Facility and/or Recycling Containment
Type of Facility:
Recycling Facility
Recycling Containment*
Type of action:
Permit
Registration
Modification
Extension
Closure
Other (explain) ___________________
* At the time C-147 is submitted to the division for a Recycling Containment, a copy shall be provided to the surface owner.
Be advised that approval of this request does not relieve the operator of liability should operations result in pollution of surface water, ground water or the environment.
Nor does approval relieve the operator of its responsibility to comply with any other applicable governmental authority's rules, regulations or ordinances.
1.
Operator: ______________________________________________(For multiple operators attach page with information) OGRID #:_______________
Address: ____________________________________________________________________________________________________________________
Facility or well name (include API# if associated with a well): __________________________________________________________________________
OCD Permit Number: ___________________________(For new facilities the permit number will be assigned by the district office)
U/L or Qtr/Qtr ______________ Section ____________ Township ____________ Range ____________ County: ________________________________
Surface Owner:
Federal
State
Private
Tribal Trust or Indian Allotment
2.
Recycling Facility:
Location of recycling facility (if applicable): Latitude __________________________ Longitude __________________________ NAD83
Proposed Use:
Drilling*
Completion*
Production*
Plugging *
*The re-use of produced water may NOT be used until fresh water zones are cased and cemented
Other, requires permit for other uses. Describe use, process, testing, volume of produced water and ensure there will be no adverse impact on
groundwater or surface water.
Fluid Storage
Above ground tanks
Recycling containment
Activity permitted under 19.15.17 NMAC explain type___________________________
Activity permitted under 19.15.36 NMAC explain type:___________________________
Other explain __________________________
For multiple or additional recycling containments, attach design and location information of each containment
Closure Report (required within 60 days of closure completion):
Recycling Facility Closure Completion Date:_______________________
3.
Recycling Containment:
Annual Extension after initial 5 years (attach summary of monthly leak detection inspections for previous year)
Center of Recycling Containment (if applicable): Latitude _________________________ Longitude _______________________ NAD83
For multiple or additional recycling containments, attach design and location information of each containment
Lined
Liner type: Thickness _________mil
LLDPE
HDPE
PVC
Other ___________________________
String-Reinforced
Liner Seams:
Welded
Factory
Other _______________________ Volume: __________bbl Dimensions: L______ x W______ x D______
Recycling Containment Closure Completion Date:_______________________
Oil Conservation Division
Page 1 of 3
4.
Bonding:
Covered under bonding pursuant to 19.15.8 NMAC per 19.15.34.15(A)(2) NMAC (These containments are limited to only the wells owned or
operated by the owners of the containment.)
Bonding in accordance with 19.15.34.15(A)(1). Amount of bond $_________________ (work on these facilities cannot commence until bonding
amounts are approved)
Attach closure cost estimate and documentation on how the closure cost was calculated.
5.
Fencing:
Four foot height, four strands of barbed wire evenly spaced between one and four feet
Alternate. Please specify________________________________________
6.
Signs:
12”x 24”, 2” lettering, providing Operator’s name, site location, and emergency telephone numbers
Signed in compliance with 19.15.16.8 NMAC
7.
Variances:
Justifications and/or demonstrations that the proposed variance will afford reasonable protection against contamination of fresh water, human health, and the
environment.
Check the below box only if a variance is requested:
Variance(s): Requests must be submitted to the appropriate division district for consideration of approval. If a Variance is requested, include the
variance information on a separate page and attach it to the C-147 as part of the application.
If a Variance is requested, it must be approved prior to implementation.
8.
Siting Criteria for Recycling Containment
Instructions: The applicant must provide attachments that demonstrate compliance for each siting criteria below as part of the application. Potential
examples of the siting attachment source material are provided below under each criteria.
General siting
Ground water is less than 50 feet below the bottom of the Recycling Containment.
Yes
No
NM Office of the State Engineer - iWATERS database search; USGS; Data obtained from nearby wells
NA
Within incorporated municipal boundaries or within a defined municipal fresh water well field covered under a municipal ordinance
Yes
No
adopted pursuant to NMSA 1978, Section 3-27-3, as amended.
NA
-
Written confirmation or verification from the municipality; written approval obtained from the municipality
Within the area overlying a subsurface mine.
Yes
No
-
Written confirmation or verification or map from the NM EMNRD-Mining and Minerals Division
Within an unstable area.
-
Engineering measures incorporated into the design; NM Bureau of Geology & Mineral Resources; USGS; NM Geological
Yes
No
Society; topographic map
Within a 100-year floodplain. FEMA map
Yes
No
Within 300 feet of a continuously flowing watercourse, or 200 feet of any other significant watercourse, or lakebed, sinkhole, or playa
Yes
No
lake (measured from the ordinary high-water mark).
-
Topographic map; visual inspection (certification) of the proposed site
Within 1000 feet from a permanent residence, school, hospital, institution, or church in existence at the time of initial application.
Yes
No
-
Visual inspection (certification) of the proposed site; aerial photo; satellite image
Within 500 horizontal feet of a spring or a fresh water well used for domestic or stock watering purposes, in existence at the time of
Yes
No
initial application.
-
NM Office of the State Engineer - iWATERS database search; visual inspection (certification) of the proposed site
Within 500 feet of a wetland.
Yes
No
US Fish and Wildlife Wetland Identification map; topographic map; visual inspection (certification) of the proposed site
-
Oil Conservation Division
Page 2 of 3
9.
Recycling Facility and/or Containment Checklist:
Instructions: Each of the following items must be attached to the application. Indicate, by a check mark in the box, that the documents are attached.
Design Plan - based upon the appropriate requirements.
Operating and Maintenance Plan - based upon the appropriate requirements.
Closure Plan - based upon the appropriate requirements.
Site Specific Groundwater Data -
Siting Criteria Compliance Demonstrations –
Certify that notice of the C-147 (only) has been sent to the surface owner(s)
10.
Operator Application Certification:
I hereby certify that the information and attachments submitted with this application are true, accurate and complete to the best of my knowledge and belief.
Name (Print): _________________________________________________________
Title: ______________________________________________
Signature:_______________________________________________________________
Date: ____________________________________________
e-mail address:________________________________________________________
Telephone: ___________________________________________
11.
OCD Representative Signature: _________________________________________________________ Approval Date: _______________________
Title: _______________________________________________________
OCD Permit Number:_______________________________________
OCD Conditions _______________________________________________
Additional OCD Conditions on Attachment
Oil Conservation Division
Page 3 of 3
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